Concurrent use of tobacco and other drugs is a concerning public health issue. Research finds that concurrent use adds to the risk of poor health outcomes caused by each drug. People who use both tobacco and alcohol are 35 times more likely to develop mouth and throat cancer compared to those who don’t use tobacco or alcohol at all.

Tobacco is the leading cause of preventable death and disease in Australia. In the context of alcohol and other drug (AOD) recovery, many people who successfully overcome their substance use disorder and still smoke will be impacted by a smoking-related disease in their lifetime. In alcohol and other drug (AOD) services, people usually present during a crisis, and addressing tobacco dependence is not made a priority. Unfortunately, this means that this highly preventable dependence is often not being sufficiently addressed.

What drugs are concurrently used with tobacco?
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Alcohol

Research shows that tobacco smoking increases uptake of alcohol. This connection works both ways, with people who drink regularly more likely to smoke. Concurrent use of both drugs triggers a bigger release of dopamine which increases enjoyment. This and other contributing factors can increase the chances of some people becoming more dependent on both drugs. People who are dependent on both drugs can experience more intense withdrawal symptoms and are more likely to relapse, making it more difficult to maintain progress made during treatment. Receiving treatment for their alcohol dependence only is less likely to lead to long term abstinence compared to when alcohol and tobacco dependence is treated together.
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Cannabis‍

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In Australia, people who use cannabis are more likely to use tobacco, than people who do not use cannabis. People who use cannabis more regularly are more likely to also use tobacco, compared to people who use cannabis less regularly. Concurrent use of cannabis increases the health risks of smoking each drug alone. Also, people who use tobacco and cannabis concurrently find it harder to quit each drug, compared to people who only use cannabis. People with an addiction to cannabis and tobacco will have a better chance at quitting if AOD services address tobacco as well as cannabis.

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Heroin

Approximately 96% of people entering heroin treatment in Australia in 2002 also consumed tobacco in the month leading to treatment. This means that many people that present with heroin dependence also need treatment for tobacco dependence.

What evidence is there to support offering tobacco treatment among AOD users?
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Stopping smoking has been shown to reduce alcohol consumption. A USA study reported that abstaining from smoking for 5 years contributed to a 50% reduction in alcohol consumption. Another study revealed that strategies that focus only on smoking cessation are associated with significant reductions in alcohol consumption, showing that smoking cessation has a strong impact on supporting people’s recovery from their other drug dependence.

Research also demonstrated a wide support for treatment for tobacco and other drugs alongside each other. A meta-analysis reported that people who received treatment for both tobacco and other drug use were 25% more likely to have long-term abstinence from alcohol and other drugs, compared to those who did not receive treatment for their tobacco dependence. This shows that interventions that address tobacco use can have beneficial effects on recovery of alcohol and other drug dependence.
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What can AOD services do?

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The alarming data on the concurrent use of alcohol and tobacco among priority populations call for AOD services to integrate tobacco dependence treatment strategies into the routine care their service provides. AOD services are best placed to provide tobacco dependence treatment support in a healthy smoke-free environment, due to the numerous health, social and financial benefits of quitting including the impact on improved AOD recovery. Helping clients to address their tobacco dependence provides a more holistic service and an environment that provides them the best chance for sustaining their recovery long-term.
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Brief advice: Ask, Advise, Help (AAH)

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The AAH brief advice model is an effective tool to help identify people who smoke and connecting them to evidence-based tobacco dependence treatment. This model follows three steps which include:
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1.     Ask all clients about their smoking status and document this answer in their case file.
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2.     Advise all clients who smoke to quit, in a non-confrontational and personalised way that focuses on the benefits of quitting, and advise of the best way to quit.
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3.     Help clients by offering to make a referral to Quitline (13 78 48). Facilitate access to stop smoking medications such as nicotine replacement therapy (NRT). See this page for more information on evidence-based cessation methods.
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Training for AOD workers
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People working at AOD services are strongly encouraged to complete smoking cessation brief advice training. Please click here for more details on smoking cessation brief advice training.
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Harry Hunter Rehabilitation Centre
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Click here to see how Harry Hunter Rehabilitation Centre made tobacco dependence treatment a part of the routine care their service provides.
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If your AOD service would like to implement a similar project, please contact makesmokinghistory@cancerwa.asn.au

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Last updated 16 December 2022